Provider Demographics
NPI:1568439263
Name:CANADY, AMANDA M (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:CANADY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:600 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8780
Mailing Address - Country:US
Mailing Address - Phone:316-283-2700
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8780
Practice Address - Country:US
Practice Address - Phone:216-281-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682127367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
092543OtherRE-CERT #
TX172351201Medicaid
TX84799UOtherBCBS PROV #
OK200050380AMedicaid
KS200423560AMedicaid
KS145437OtherBCBS
KS145437OtherBCBS
KS145437Medicare PIN
P00192563Medicare ID - Type UnspecifiedRR PROV #